rFVIIa therapy should only used in a patient with an inhibitor when clinically significant bleeding is a concern. It is too expensive (> $10,000 per dose) for casual use, and it may be associated with thrombotic complications.
When rFVIIa should be considered:
(1) vigorous uncontrolled bleeding
(2) impending compartment syndrome with limb threatened
(3) bleeding into a critical location
(4) major bleed into a joint with severe pain and risk for a crippling deformity
(5) persistent bleeding uncontrolled by other means
(6) before major surgery with significant risk of bleeding, especially orthopedic surgery
The usual dose is 90 micrograms per kilogram every 2-3 hours until hemostasis is achieved. In patients with persistent bleeding the dose may be lower and less frequent. Lean body weight (rather than actual) should probably be used.
Dosing is less frequent once hemostasis is achieved and is titrated based on bleeding severity.
